| NPI | 1265639025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301090107) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301090107) |
| 208000000X Pediatrics (Licence: MI 4301090107) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301090107) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2019-11-19 |